CPT Code 44227: Laparoscopy, Colectomy with Anastomosis and Resection of Terminal Ileum

Learn how to report CPT code 44227 for laparoscopic colectomy with ileum resection and enterostomy closure, including documentation and billing guidelines.

Use Code

What is CPT code 44227?

Current procedural terminology (CPT) code 44227 refers to a laparoscopic surgical procedure involving partial colectomy (removal of part of the large intestine except the rectum) with anastomosis (surgical reconnection of the bowel) and resection of the terminal ileum. This code also includes the closure of a previously created enterostomy, whether involving the large or small intestine. The laparoscopic approach allows for minimally invasive access through small incisions in the abdominal wall, using specialized instruments and a camera for visualization.

The procedure is typically performed when a patient requires removal of diseased or damaged sections of the colon and terminal ileum, often due to conditions such as Crohn’s disease, cancer, or complicated diverticulitis. In cases where a previously created enterostomy needs to be reversed during the same operative session, CPT 44227 is the appropriate code to report the primary procedure.

Documentation requirements

Thorough documentation is essential for ensuring accurate billing, supporting medical necessity, and complying with payer policies when reporting CPT code 44227.

Clinical rationale and indications

Medical records must clearly document the clinical indication for performing the procedure, such as malignancy, bowel obstruction, or inflammatory bowel disease. If a previous enterostomy was closed, the rationale for closure should also be included, along with the patient’s symptoms, response to prior treatment, and any complications associated with the stoma.

Procedure details

The operative note should describe the laparoscopic approach in detail, including trocar placement, identification and resection of the terminal ileum, partial colectomy, creation of the anastomosis, and closure of the enterostomy. Any intraoperative findings, such as adhesions, bleeding, or anatomical variations, should be noted. If the procedure was discontinued, include the reason and extent of the services provided up to that point.

Provider roles and settings

Specify whether a physician, nurse practitioner, or qualified resident surgeon performed the procedure. This is important for determining the appropriateness of billing and for compliance with American Medical Association (AMA) coding guidance and payer rules.

Billing and coding guidelines

To ensure accurate billing and compliance, documentation for CPT 44227 must reflect all key components of the procedure. Proper use of modifiers, code selection, and payer-specific rules is essential to avoid denials.

Proper use of CPT 44227

CPT 44227 should only be used when all components of the code, laparoscopic colectomy, terminal ileum resection, and closure of a previously created enterostomy, are performed during the same operative session. It is not appropriate for partial procedures unless they are documented as discontinued and supported by the operative report.

Modifiers and multiple procedures

If other procedures are performed during the same session, such as hernia repair or adhesiolysis, modifiers may be required. If only the professional or technical component is being billed, modifiers -26 or -TC should be used accordingly. Always ensure modifiers are applied in line with CPT and National Correct Coding Initiative (NCCI).

Medicare and payer-specific rules

Coverage and reimbursement may vary by payer, including Medicare. Verify whether the closure of enterostomy is bundled or reimbursed separately. Also, confirm documentation and diagnosis code requirements to avoid claim denials, especially when reporting complex or multi-component procedures on the intestines.

Other related CPT codes

44144: Open partial colectomy with anastomosis and enterostomy closure
44204: Laparoscopic partial colectomy with anastomosis, without ileal resection

Frequently asked questions

No. If the enterostomy closure was not performed, report the appropriate laparoscopic colectomy code without enterostomy closure (e.g., 44204), and document accordingly.

Yes, if extensive lysis of adhesions added significant complexity and time to the case, modifier -22 may be used, with detailed documentation to support it.

Yes, but services must be billed under appropriate supervision rules and scope-of-practice laws. Assistant surgeon modifiers (e.g., modifier -80) may be applied when reporting services provided by assisting providers.